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A gap in government health care programs leaves many adults seeking dental care in hospital emergency departments. Medicaid programs in 10 states offer no dental benefits for adults, and most other states offer limited care, according to the American Dental Association. Medicare does not cover cleanings, fillings, extractions or dentures, a program spokeswoman said. "What this does is funnel everyone to the ER, which is the most expensive place to get health care," emergency department physician Alan Sorkey said.

Pennsylvania expanded its Medicaid program to cover most low-income adults, and dental benefits include coverage for regular checkups, fillings and one set of dentures, but it does not routinely cover crowns or root canals. Dentists and patient advocates say the coverage is inadequate. Most health insurance plans sold through the Affordable Care Act exchange do not cover adult dental care, and no subsidies are offered for standalone plans.

Some 64,000 children in three Michigan counties have been enrolled in the state’s Healthy Kids Dental program, administered by Delta Dental and the state Department of Community Health. Coverage includes examinations, cleanings, fluoride treatments, X-rays, emergency treatment, root canals, extractions, dentures, spacers, crowns and sealants. Officials hope to expand the program into the remaining five counties not currently included.

About 200 U.S. communities have stopped adding fluoride to their water supplies in an effort to save money, but CDC figures show that each dollar spent on fluoridation saves an estimated $38 in dental treatment expenses. "In the years ahead, removal of fluoride from drinking water will almost certainly cost taxpayers millions of dollars in increased Medicaid expenditures," writes Jane Brody.

A bill before the California Legislature would authorize the state to study the costs and benefits of allowing midlevel providers to perform certain dental services. A growing number of children in the state don't have access to dental care, and demand is likely to increase as the health care reform law is implemented. At least one state dental organization supports the bill, but others say midlevel providers do not have appropriate training to perform irreversible procedures.